Anomalous origin of left coronary artery from pulmonary artery associated with pulmonary hypertension

Area of Science:

• Pediatric Cardiology
• Diagnostic Imaging
• Congenital Heart Disease

Background:

• Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart defect.
• Patients often present with symptoms of heart failure and myocardial infarction.
• Early diagnosis and intervention are crucial for survival.

Purpose of the Study:

• To report a case of ALCAPA in a 10-year-old child with severe pulmonary hypertension and myocardial infarction.
• To introduce a new echocardiographic view (posterior pulmonary cusp view) for improved visualization of anomalous coronary artery origin.
• To discuss echocardiographic pitfalls and diagnostic hints in ALCAPA.

Main Methods:

• Echocardiography, including a novel posterior pulmonary cusp view, was used for diagnosis.
• The study highlights specific echocardiographic pitfalls and provides guiding hints for clinicians.
• The case involved a child with ALCAPA, severe pulmonary hypertension, myocardial infarction, and poor collateralization.

Main Results:

• The posterior pulmonary cusp view facilitated visualization of the anomalous origin of the left coronary artery.
• Three echocardiographic pitfalls and two diagnostic hints were identified.
• The child survived due to life-saving pulmonary hypertension, preserving left ventricular function despite limited infarction and mitral regurgitation.

Conclusions:

• A novel echocardiographic view can aid in diagnosing ALCAPA and overcoming diagnostic challenges.
• Pulmonary hypertension can paradoxically be life-saving in ALCAPA by preserving left ventricular function.
• Successful medical management is possible in select ALCAPA cases with careful monitoring.